| NPI | 1780338665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1002755-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11901) |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2026-09-08 |